Antidepressant drugs cause a variety of sexual side-effects. However,
antidepressant-induced changes in sexual sensations are rare. We report a case
of fluoxetine-induced loss of sensation of vagina and nipples.

A 48-year-old married woman with recurrent depression had good
antidepressant response to fluoxetine 20 mg. However, her compliance with the
medication was poor resulting in recurrences. While euthymic and on no
antidepressants, her sexual function was normal. When depressed she has
moderate decrease in libido. With fluoxetine 20 mg her depression remitted and
her libido returned to normal. However, she developed a complete loss of
sexual sensation of her nipples and vagina. Touch and pain sensations were
also impaired, but only to a lesser extent. This lead to decreased
satisfaction with sexual life and consequently poor compliance with the
medication. Even when she became briefly hypomanic on fluoxetine, the lack of
sensation persisted. We substituted her fluoxetine with trazodone 400 mg. She
remained euthymic. By the fifth week her vaginal and nipple sensations
returned to normal. The frequency of sexual inter-course and satisfaction
improved to premorbid levels.

This is the first report of fluoxetine-induced loss of sensation of vagina
and nipples. Fluoxetine-induced anaesthesia of penis
(Neill, 1991;
Measom, 1992) and vagina
(King & Horowitz, 1993),
which did not improve with dosage reduction or addition of cyproheptadine, but
did with discontinuation of fluoxetine, have been reported. Ellison &
DeLuca (1998) reported a case
of genital anaesthesia caused by fluoxetine that did not improve with addition
of cyproheptadine or yohimbine but responded to Ginkgo biloba. Ginkgo
biloba is a Chinese herbal remedy for a variety of disorders and has
diverse neurochemical effects. The mechanism of antidepressant-induced sexual
anaesthesia remains elusive. The fact that the anaesthesia persisted even
during the fluoxetine-induced hypomanic state confirms that this was not part
of the depressive syndrome.

Sexual side-effects of antidepressant drugs cause distress, strain
relationships, impair quality of life and reduce compliance with treatment.
Enquiring routinely about side-effects, especially sexual side-effects of
antidepressants, would help to improve compliance with treatment.